长节段骨水泥钉道强化椎弓根螺钉治疗Ⅲ期Kummell病的临床研究

Clinical study on long-segment cement-augmented pedicle screw fixation for the treatment of stage Ⅲ Kummell disease

摘要:

目的 探讨长节段骨水泥钉道强化椎弓根螺钉治疗Ⅲ期Kummell病的临床疗效。方法 选取2020年2月—2025年2月鹰潭一八四医院收治的136例Ⅲ期Kummell病患者，采用随机数字表法分为常规组（68例，传统椎弓根螺钉治疗）和研究组（68例，长节段骨水泥钉道强化椎弓根螺钉治疗），术后随访6个月，比较两组围手术期指标、疼痛程度、脊柱功能情况、影像学指标、生物力学指标和并发症发生率。结果 研究组手术时间长于常规组（P <0.05），术中出血量高于常规组（P <0.05），住院时间短于常规组（P <0.05）。常规组与研究组术前视觉模拟评分法（VAS）评分、Oswestry功能障碍指数（ODI）比较，差异均无统计学意义（P >0.05）。研究组术后6个月VAS评分、ODI均低于常规组（P <0.05）。研究组术前与术后6个月VAS评分、ODI的差值均大于常规组（P <0.05）。常规组与研究组术前椎体前缘高度比、椎体楔变角、脊柱整体Cobb角比较，差异均无统计学意义（P >0.05）。研究组术后6个月椎体前缘高度比高于常规组（P <0.05），椎体楔变角、脊柱整体Cobb角低于常规组（P <0.05）。研究组术前与术后6个月椎体前缘高度比、椎体楔变角、脊柱整体Cobb角的差值均大于常规组（P <0.05）。传统固定组最大轴向拔出力和抗扭转力矩均低于骨水泥强化组（P <0.05）。研究组并发症总发生率低于常规组（P <0.05）。结论 长节段骨水泥钉道强化椎弓根螺钉内固定力学稳定性更优，应用于Ⅲ期Kummell病患者可缓解疼痛，促进脊柱功能恢复，恢复病椎高度，矫正脊柱畸形，降低并发症发生率。

Abstract:

Objective To investigate the clinical efficacy of long-segment cement-augmented pedicle screw fixation in the treatment of stage III Kummell disease.Methods A total of 136 patients with stage III Kummell disease admitted to Yingtan 184 Hospital between February 2020 and February 2025 were selected and randomly assigned via a random number table to either the conventional group (n = 68, treated with traditional pedicle screw fixation) or the study group (n = 68, treated with long-segment cement-augmented pedicle screw fixation). All patients were followed up for 6 months postoperatively. Perioperative indicators, pain intensity, spinal function, radiographic parameters, biomechanical indicators, and complication rates were compared between the two groups.Results The study group had a longer operative time, greater intraoperative blood loss, and a shorter hospital stay than the conventional group (all P < 0.05). Preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores did not differ significantly between the two groups (P > 0.05). At 6 months postoperatively, VAS and ODI scores were lower in the study group than in the conventional group, and the preoperative-to-postoperative changes in both scores were greater in the study group (all P < 0.05). Preoperative anterior vertebral body height ratio, vertebral wedge angle, and global spinal Cobb angle did not differ significantly between the groups (P > 0.05). At 6 months postoperatively, the study group had a higher anterior vertebral body height ratio and lower vertebral wedge angle and global spinal Cobb angle than the conventional group; the preoperative-to-postoperative changes in all three parameters were also greater in the study group (all P < 0.05). The maximum axial pullout force and torsional resistance were lower in the traditional fixation group than in the cement-augmented group (P < 0.05). The total complication rate was lower in the study group than in the conventional group (P < 0.05).Conclusion Long-segment cement-augmented pedicle screw fixation provides superior stability. Its application in patients with stage III Kummell disease can effectively alleviate pain, promote the recovery of spinal function, restore vertebral height, correct spinal deformity, and reduce the incidence of complications.